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Table 3 Markers used to assess atropine toxicity

From: Early management after self-poisoning with an organophosphorus or carbamate pesticide – a treatment protocol for junior doctors

Confusion
Pyrexia
Absent bowel sounds (Urinary retention)
  1. Notes:
  2. Many factors can cause confusion and pyrexia. However, confusion and/or pyrexia in the absence of bowel sounds suggests that they are due to atropine toxicity and will respond to a reduction in the rate of atropine administration.
  3. Alcohol withdrawal, requiring benzodiazepine therapy, must be considered in poisoned patients who are confused.
  4. Control pyrexia as soon as possible; conditions causing pyrexia include agitation from alcohol withdrawal or atropine toxicity, atropine-induced failure to sweat, and high ambient temperature. Active cooling of the patient with fan and water-soaked towels must be a priority because they are at risk of hyperthermia-induced cardiac arrest. Most ill patients will be catheterised after resuscitation to observe urinary output. Urinary retention can therefore not then be used as a marker of toxicity.